2018 MIDTERM ELECTION

Time: D H M S

 

One of the great strengths and dangers of the ACA is that it includes tools for individual states to modify the law to some degree by improving how it works at the local level. The main way this can be done is something called a "Section 1332 State Innovation Waiver":

Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.

State Innovation Waivers allow states to implement innovative ways to provide access to quality health care that is at least as comprehensive and affordable as would be provided absent the waiver, provides coverage to a comparable number of residents of the state as would be provided coverage absent a waiver, and does not increase the federal deficit.

UPDATED 6/22/18: Added Indiana and Iowa to the table.
UPDATED 6/25/18: Added Florida, Kentucky, Ohio and Texas* to the table
*(Texas only has about 1/3 of the total ACA individual market accounted for, so it could easily change)
UPDATED 7/3/18: Added Montana and Georgia to the table
UPDATED 7/13/18: Added Tennessee, updated Texas to add BCBSTX
UPDATED 7/16/18: Added Colorado
UPDATED 7/17/18: Added Nevada
UPDATED 7/19/18: Added California
UPDATED 7/20/18: Added Connecticut

Fire up the Wayback Machine, Peabody, and take us to September 2015:

AP's NEW "HC.gov Security Flaws" story attacks problems FIXED UP TO A YEAR AGO.

Last night I posted what seemed, at first, to be a merely-amusing (if a bit depressing) story about a Florida news station website accidentally (?) reposting a year-old AP newswire story about potential security vulnerabilities at Healthcare.Gov:

"Critical" flaw found in HealthCare.gov security

WASHINGTON -- The government's own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability - but also came away with respect for some of the health insurance site's security features.

Those are among the conclusions of a report released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud.

 

As I've written about many times before, my home state of Michigan is, unfortunately, among the states which are trying to institute work requirements for ACA Medicaid expansion for 680,000 Michiganders. As I've also written about many times before, work requirements for Medicaid are not only burdensome and cruel, they're counterproductive in terms of efficiency, economics and even in the stated goal of such programs, which is supposedly to "inspire" low-income people to get a job.

Michigan’s Medicaid Proposal Would Harm Low-Income Workers — And Can’t Be Fixed

Specifically, the Michigan bill, or any similar proposal, would:

Last year I wrote a LOT about Silver Loading and Silver Switching for 2018...basically, the way which ACA individual market enrollees can save hundreds or even thousands of dollars on their 2018 insurance policies by taking advantage--perfectly legally and ethically--of the unusual pricing of different metal level policies this year.

The short version is this: Due to the way the ACA's tax credit formula works, Donald Trump's attempt at sabotaging the ACA exchanges by cutting off Cost Sharing Reduction (CSR) reimbursement payments to insurance carriers actually (partly) backfired on him, resulting in an unusual situation in which several million subsidized enrollees ended up benefitting from the pricing fallout, while millions of unsubsidized enrollees ended up being hurt by it...but other unsubsidized enrollees ended up being able to avoid being hurt by switching to a special off-exchange Silver plan (thus, the "Silver Switch").

OK, I had kind of forgotten about this. Back in early June, insurance carriers in Pennsylvania submitted their preliminary 2019 ACA market premium change requests. At the time, they averaged around a 4.9% increase statewide, which seemed pretty impressive under the circumstances.

Then, late July, the PA insurance department issued a press release stating that state regulators had modified the 2019 requests, and that the new, revised average was much lower...a mere 0.7% average rate hike. However, the individual carriers as well as the insurance department made it very clear that this nominal increase included a 6 point rate increase to account for the ACA's individual mandate being repealed and the Trump Administration's expansion of non-ACA compliant short-term and association plans.

I originally wrote about District of Columbia carrier requested 2019 ACA rate changes back in June. At the time, they were seeking a weighted average increase of around 15.5% across the District.

However, the DC exchange board was also working quickly in an attempt to counter the Trump Administration's #ACASabotage factors, by voting to restrict short-term plans, to lock in DC's Open Enrollment Period at a full 3 months as in years past, and to reinstate the ACA's individual mandate penalty at the local level.

As of early September, all of these things appeared to have been approved by the exchange board and/or the DC Council.

On September 19, the DC Dept. of Insurance, Securities & Banking posted the approved 2019 ACA rate changes, and the average increase for the individual market had been shaved down from 15.5% to 13.0%:

Not much more to add to this:

McConnell says Senate Republicans might revisit Obamacare repeal

WASHINGTON (Reuters) - Republicans could try again to repeal Obamacare if they win enough seats in U.S. elections next month, Senate Republican Leader Mitch McConnell said on Wednesday, calling a failed 2017 push to repeal the healthcare law a “disappointment.”

...except that the headline understates what McConnell actually said:

...On Nov. 6, Americans will vote for candidates for the Senate and the House of Representatives.

McConnell’s Republicans now hold majority control of both chambers. Democrats will try to wrest control in races for all 435 House seats and one-third of the 100 Senate seats.

Despite their dominance of Congress and the White House, Republicans dramatically failed last year to overturn former President Barack Obama’s signature healthcare law, known as Obamacare. McConnell called it “the one disappointment of this Congress from a Republican point of view.”

(image via Arkham City Wiki...artist unknown)

(note: this is a work in progress...check back soon for more additions.)

As I noted yesterday, as the 2018 midterm election rapidly approaches, there's been a sudden and complete change in strategy when it comes to healthcare policy campaiging by practically every Republican running for office this year. After nearly a decade of doing everything in their power to attack, undermine, sabotage, hack away at, trash and especially repeal the Patient Protection and Affordable Care Act (that's the full title of the law, after all), GOP candidates have suddenly decided that "protecting coverage of pre-existing conditions" is a swell idea after all.

I analysed Kansas' 2019 ACA indy market rate changes back in August. The three carriers were requesting an average increase of around 6.1% (this may be slightly off since I had to estimate the market share for two of the three). State insurance regulators left Blue Cross Blue Shield and Ambetter's rate requests as is, but cut Medica's down by more than half, from a 10.7% increase to just 4.3%:

Premium Rates for Individual and Small Group Markets Individual plan premium rates may vary by age, rating area, family composition and tobacco usage. For example, a person living in Manhattan, KS (rating area 3) may pay a different rate than someone living in Pittsburg, KS (rating area 7) based on the claims data by rating area. A map of the counties included in each rating area is provided on the next page. Kansas is an effective rate review state, which means the actuarial review is conducted by the Kansas Insurance Department. KHIIS (Kansas Health Insurance Information System) claims data is utilized during the rate review process to verify the claims experience submitted by the companies. The following table provides details regarding the average requested rate revisions for companies writing individual policies in Kansas. Rate increases will be partially offset for individuals receiving a premium tax credit.

Back in June, Indiana's 3 individual market carriers submitted their requested 2019 ACA rate changes, which averaged around 5.1%. At the time I also pegged the impact of #ACASabotage on 2019 rates (mandate repeal + #ShortAssPlans) at around 13 percentage points.

This week I've found Indiana's approved 2019 rate changes for the individual and small group markets. State regulators cut the overall average increase for the individual market in half, to just 2.6%:

Last month, the Idaho Insurance Department posted the preliminary 2019 ACA individual market rate change requests. They were pretty straightforward, averaging around an 8% increase across the market.

A few days ago, the Idaho DOI issued their final/approved rate changes, knocking a few points off the hikes and bringing the weighted average increase down to 5%:

The Department of Insurance received preliminary 2019 health plan information from insurance carriers on June 1 and began reviewing the proposed plan documents and rates for compliance with Idaho and federal regulations. The Department of Insurance does not have the authority to set or establish insurance rates, but it does have the authority to deem rate increases submitted by insurance companies as reasonable or unreasonable. After the review and negotiation process, the carriers submit their final rate 2019 increase information. The public is invited to provide comments on the rate changes. Please send any comments to Idaho Department of Insurance.

 

A few days ago, Jonathan Cohn of the Huffington Post wrote about a new phenomenon sweeping the nation: Republican candidates, all of whom have repeatedly either voted to repeal the Patient Protection & Affordable Care Act or who have repeatedly called for it to be repealed, are suddenly falling all over themselves to try and claim that they support patient protections for those with pre-existing conditions...usually by invoking family members who suffer from various ailments.

Cohn's examples include GOP Congressman Mike Bishop (MI-08), who claims his wife has rheumatoid arthritis; Dana Rohrabacher (CA-48), who says his daughter survived childhood leukemia; John Faso (NY-19) and Mario Diaz-Balart (FL-25), both of whose wives survived cancer; and Josh Hawley (MO-AG, running for MO-Sen), whose son has a rare chronic disease.

Yes, that's right...while the 2019 Open Enrollment Period doesn't start for the rest of the country until November 1st, the Golden State has decided to kick things off two weeks early (16 days early, technically): Covered California, the largest state-based ACA exchange, is officially open for business for 2019 enrollment as of today!

In addition, while you can't actually enroll for 2019 coverage in any other state until November 1st, in several states you can window shop to find out what your 2019 policy options and pricing will be, along with estimates about what sort of financial assistance you'll qualify for once you actually do go through the enrollment process.

The states which are already open for window shopping already include:

Last year, while Congressional Republicans were doing everything possible to officially repeal the Affordable Care Act via legislative means, Donald Trump spent months repeatedly threatening to cause the ACA individual market exchanges to either "explode" or "implode" (depending on the day) by, among other things, cutting off Cost Sharing Reduction reimbursement payments to insurance carriers.

As I've explained many times before, Trump thought that his cutting off CSR payments would cause the insurance carriers to flee the markets altogether. He also thought his actions would simply cause low-income ACA enrollees to lose the financial assistance they were receiving to cover deductibles and other out-of-pocket expenses altogether, which is a reasonable assumption if you don't understand how CSRs actually works (which I guarantee you Trump doesn't).

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